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Tuberculosis Is Rising Again, and Is Puzzling Our Drugs

Aided by poor treatment adherence, a new-old threat looms.
Tuberculosis x-ray (Wikimedia Commons)

Airborne tuberculosis is as old as humankind, with traces of the infectious disease found in prehistoric skeletons dating back to 4000 BC. And while our civilization has adapted from caves and clay vases to skyscrapers and digital toys, so too has the disease known historically as "the consumption." The nickname comes from the illness's tendancy to cause extreme weight loss in its victims, along with fevers and a characteristic bloody cough. TB is a bacterial infection that usually attacks the lungs first, before moving to other organs and, quite possibly, killing its host.

Drug-resistant tuberculosis is now a problem in former Soviet satellites in Europe as well as those that border Russia, like Finland) and in various Asian countries, including North Korea. In recent years, multiple cases have broken out in South Africa, India, Peru, Mexico, and the Southwestern United States. While most cases are multi-drug resistant tuberculosis (MDR TB), Australia saw its first death to extensively drug-resistant tuberculosis (XDR TB) last month. As of right now, XDR TB has no known cure.

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Are we on the brink of an epidemic? Maybe. People who have TB sometimes don’t display symptoms for months, a key ingredient in the successful spread of a disease (like HIV, which hides its symptoms for potentially years).

According to a global report from the Centers for Disease Control and Prevention (CDC) in 2012, 33 percent of TB patients in Thailand were resistant to current drugs, and 62 percent in Latvia were. XDR TB was found in 15.2 percent of the patients in South Korea and 11.3 percent in Russia.

The spread of the less-threatening MDR TB throughout Eastern Europe can be attributed to the Russian prisons and labor camps, where the infectious disease has been a problem since the mid-90’s.

In 1996, the New York Times reported on how the Kazakstan government “released about 56,000 prisoners under an amnesty, many of them suffering from drug-resistant tuberculosis according to the Global TB Education Fund in Washington.”

A mini-documentary by the International Committee of the Red Cross on the spread and treatment of drug-resistant tuberculosis in Azerbaijan prisons illustrates how and why the disease spreads: Repeat offenders will re-enter the prison without completing treatment, and then infect their family, friends, and neighbors.

In poor countries like North Korea, which is currently battling what outlets describe as an “epidemic” of drug-resistant TB, the resources and medicine to treat the disease are in short supply. The Wall Street Journal reported last month treatment for MDR TB in the US costs on average $140,000, but can be as costly as $700,000. The White Death may have started as a poor man’s disease, but its spread is not entirely related to poverty.

Patients that start taking the medicine only to stop before treatment is completed run the risk of developing XDR/MDR TB. Yes, people failing to take their medicine has led to the disease mutating into something incurable. The Times of India describes MDR TB as “a man made phenomenon by doctors as it is caused by irregular intake of prescribed drugs.” XDR TB forms after MDR TB has been improperly treated over a number of years.

Perhaps it time to make the Black Death mask cool again.